New guide spells out no-cost coverage for RSV, COVID, and flu shots

Related: Catastrophic injuries cost employers $15B annually

Here is a summary of WTW’s update:

• Influenza vaccine: The current recommendation (unchanged from last year) is that all people six months and older receive an annual flu shot. Still, only about 45% of adults and 55% of children received one last year. “The ACA requires that flu shots be offered without cost sharing,” according to WTW. “Employers generally cover vaccinations in both the medical and pharmacy benefits to increase member access. Multi-dose flu vaccines that had the preservative thimerosal are no longer approved or available.”
• RSV vaccine: The current recommendation is that individuals over age 75 receive the vaccine, as well as those over 50 years old with an underlying illness that puts them at greater risk of complications, and pregnant women to protect their newborns. “You’re required by the ACA to cover RSV vaccination without cost sharing for eligible pregnant women and those over age 55, and those over age 50 with risk factors consistent with the ACIP guidelines,” according to WTW.
• COVID-19 vaccine: Despite the recent change restricting COVID-19 vaccines to people over age 65 or those at high risk of complications — including pregnancy, sedentary lifestyle, depression, hypertension and diabetes — a large portion of the U.S. population remains eligible for a shot, WTW’s physicians noted, adding that “employer health plans are required to cover COVID-19 vaccinations without cost sharing.”
• Hepatitis B vaccine: The current recommendation remains unchanged and calls for a dose for newborns before hospital discharge, and subsequent doses are given between 1 and 2 months and before 18 months; three doses of the vaccine are recommended at any age for those who weren’t previously immunized. “You’re required to cover the cost of the hepatitis B vaccine with no cost sharing under the ACA,” according to WTW.
• MMRV vaccine: “The MMR vaccine should be given separately from the varicella vaccine at 12 months,” according to WTW. “The combined MMRV vaccination can be given at age four. Previously, families had the choice to give these vaccines together (an MMRV vaccine) or separately (MMR vaccine, plus a separate varicella vaccine). MMR vaccination (without varicella) is recommended at any age for those who didn’t previously have two doses or those whose blood tests show no immunity to measles. You’re required to cover the cost of MMR and varicella vaccines separately at age 12 months under the ACA. You must provide coverage for the MMRV vaccine for children age four and older.”

In September, the Northeast Business Group on health, a New York-based nonprofit employers group, issued a guide for employers about strategies for strengthening a “vaccination-friendly culture.” Created with funding from Pfizer and Merck, the guide appears as employer vaccination benefits that once had strong, bipartisan support are now affected by fierce, partisan battles in Washington over vaccination policy.

CVS and Walgreens also recently published complicated lists explaining who can receive COVID vaccines where — and how.